Steven Julius Beko/Wade Pattersona
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City of Miami Beach Office of the City Clerk 2~Q~ SEP -9 F~ 12= 0 I
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a prinripal who seeks to encourage the passage, defeat or modification of
any ordinance, resolution, action or decision of any commissioner; any action, derision, recommendation of the City Manager or any dty board or
committee; or any action, derision or recommendation of any city personnel during the time period of the entire derision-making process on such
anion, decision or recommendation that foreseeably will be heard or reviewed by the city commission, or a rity board or committee. The term
spedfically indudes the prinripal as well as any employee engaged in lobbying adivities. The term "Lobbyists" has specific exclusions. Please
refer to Ordinance 2004-3435. ^ ~O t
NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number and Street) (City) (State) (Zip Code)
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TELEPHONE NUMBER: FAX NUMBER: EMAIL:
I. LOBBYIST RETAINED BY:
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NAME OF PRINCIPAUCLIENT:
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8U5 ESS NAME AND ADDR S (Nu er and Street) Cit) (State) (Zip Code)
off- 5?I~- l"2..3 QJ~- 571- 2 ~~~
TELEPHONE NUMBER: FAX NUMBER: (ODtionall EMAIL: (Ootionall
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c)]
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
• IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN
SUCH CORPORATION, PARTNERSHIP OR TRUST:
II.SPECIFIC LOBBY ISSUE:,
v~S~TC~RS ~ CO-JV~c-~~1dN P~~c~R`Z^( GRA-~" ~13n mv~C~t Qc~~ ~U~!-~tl~
Issue to be lobbied (Describe in detail): ~ 1R1~ ~ ~~
Ill. CITY AGENCIES/INDIVIDUALS TO BE LOBBIED: Pursuant to City Code Section 2-482(g) include
a statement of the extent of any business, financial, familial, professional or other relationship, giving rise to an
appearance of an Impropriety with any City personnel sought to be lobbied -- further, pursuant to City Code Section 2-
482(a)(4) include a statement of any contractual relationship (paid or unpaid) from 12 months preceding said Clty
personnels' commencement of service with the City to the present date, stating the general nature of the subject
contractual relation.
A Full Name of Individual Title B An Financial, Familial or Professional Relationshi
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~ IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY, FLAT
RATE OR OTHER):
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A) LOBBYIST DISCLOSURE: (Required) 'S AL.L4 ~~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): ~L~~
(Required).
The following information must be answered:
1) Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
^ Yes ~ No• Are you lobbvina on a present or pendina bid for aoods equipment or services or on a
present or Dendina award for aoods, eauipment or service?
2) Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign Contributions By Lobbyists On
Real Estate Development Issues":
^ Yes ~ No• Are you lobbvina on a pendina application for a Development Aareement with the City or
application for chanae of zoning map designation or chanae to the Citv's Future Land Use
Mao?
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of snot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees.
Yes ^ No: Are you representing snot-for-profit corporation or entity without special compensation or
reimbursement. .
V. SIGNATURE UNDER OATH:
Signature of Lobbyist:
Signature of Principal/Client: __~
VI. LOBBYIST IDENTIFICATION:
^ Produced ID
Form of Identification
Personally known (Lobbyist)
PRINCIPAL IDENTIFICATION:
~ Produced ID
Form of Identification
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VII. SIGNATURE AND STAMP OF NOTARY:
Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to and subscribP~d before me Swom and subscri ed before me
This 7,-1 day d~ Hll~ollSl , 2009 This 31 day of ~ s7 , 2009
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Signature of ubli otary - St e f Florida Signature of Puli1, ip Notary -Sate f Florida
Notarizatio Lob fist's sign ure Notarizatio~o-f.P~incipa-Ps si ure
TO BE COMPLETED BY CITY CLERK'S STAFF ONLY
Annual Registration fee: [ ]Yes [ ] No Amount Paid S MCR # Date Paid
Lobbyist Registration Form received and verified by:
F:\CLER\$ALL\aFORMS\LOBBYIST FORMS\Lobbyist Registration Form 21109.doc Revised 02/11/2009
I do solemnly swear that all of the fore in fa s e and co ect and that I have read or am familiar with the
provisions contained in Section 2-482 o he is ea ity Cod and all reporting requirements.
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City of Miami Beach, 1700 Convention Center Drive, Miami Beach, Florida 33139, www.miamibeachfl.gov
CITY CLERK Office CityClerk@miamibeachfl.gov
Tel: 305.673.741 1 ,Fax: 305.673.7254
LOBBYIST NAME: ~~~~ J ~ ~~~
I understand that no later than Qttober 1st of each year, I must file the following
forms, pursuant to Section 2-485 of the Miami Beach City Code, with the City Clerk's
Office for all active lobbying issues.
1) Lobbyist Expenditure Form
2J Disclosure Form
Failure to file these forms on a timely basis will result in my name being transmitted to the
Miami-Dade County Commission on Ethics and for code violation evaluation.
In addition, one 'ssue I have registered to lobby on has been resolved, I am required
to immediately n~",,~~.'e City Clerk's Office of lobbyist withdrawal in writing.
~~ 21`0°'1
Signature: ~ Date:
F:ICLERILOBBYIST1Lobbyist Registration Form 32708.doc